HOLLAND COMMUNITY HEALTH CENTER: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- HOLLAND COMMUNITY HEALTH CENTER (EIN 20-0602574)
- Tax period
- 2022-01-01 to 2022-03-31
- Filed
- 2022-11-14
- IRS object ID
- 202243189349303614
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T09:20:04-06:00 | ReturnTs |
| Tax Period End | 2022-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 382492570 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BEENE GARTER | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 56 GRANDVILLE AVE SW STE 100 | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49503 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200602574 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLLAND COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HOLL | BusinessNameControlTxt |
| Phone | 6163943788 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 336 S RIVER AVE | AddressLine1Txt |
| City | HOLLAND | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 494233326 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CARRIE LOMBARDI | PersonNm |
| Person Title | BOARD MEMBER | PersonTitleTxt |
| Phone | 6163943788 | PhoneNum |
| Signature | 2022-09-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CARRIE | PersonFirstNm |
| Person Last | LOMBARDI | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | HOWARD L CUTLER CPA | PreparerPersonNm |
| PTIN | P00292927 | PTIN |
| Phone | 6162355200 | PhoneNum |
| Preparation | 2022-09-09 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CARRIE LOMBARDI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 336 S RIVER AVE | AddressLine1Txt |
| City | HOLLAND | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 494233326 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $499,097 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2004 | FormationYr |
| Legal Domicile State | MI | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE ACCESS TO QUALITY PRIMARY HEALTH CARE FOR ALL MEMBERS OF THE COMMUNITY WITH BOTH RESPECT AND COMPASSION. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $694,697 | PYContributionsGrantsAmt |
| CY Contributions Grants | $106,253 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $1,400,457 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $392,838 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $479 | PYOtherRevenueAmt |
| CY Other Revenue | $6 | CYOtherRevenueAmt |
| PY Total Revenue | $2,095,633 | PYTotalRevenueAmt |
| CY Total Revenue | $499,097 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,095,633 | PYOtherExpensesAmt |
| CY Other Expenses | $499,097 | CYOtherExpensesAmt |
| PY Total Expenses | $2,095,633 | PYTotalExpensesAmt |
| CY Total Expenses | $499,097 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $0 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $0 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $787,916 | TotalAssetsBOYAmt |
| Total Assets EOY | $655,155 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $787,916 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $655,155 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $0 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO IMPROVE THE HEALTH OF THE PATIENTS IN THE HOLLAND COMMUNITY BY PROVIDING QUALITY HEALTH CARE REGARDLESS OF LANGUAGE, FINANCIAL OR CULTURAL BARRIERS; THEREBY ASSURING THAT PRIMARY HEALTH CARE IS ACCESSIBLE TO ALL RESIDENTS OF THE AREA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $476,985 | ExpenseAmt |
| Revenue | $392,844 | RevenueAmt |
| Desc | PROVIDED PATIENT HEALTH CARE VISITS TO APPROXIMATELY 2,755 PATIENTS. | Desc |
| Total Program Service Expenses | $476,985 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JIM JUNEWICK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6164866708 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4420 44TH ST SE | AddressLine1Txt |
| City | KENTWOOD | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49512 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| DALE SOWDERS | ||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| SAMIR RAJANI MD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| JEAN MARTIN | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| SUE FROST | ||||||
| TREASURER/SECRETARY | 40.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| ALLISON RUND MD | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| PATTI VANDORT | ||||||
| VICE CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| CARRIE LOMBARDI | ||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SPECTRUM HEALTH MEDICAL GROUP | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 648 MONROE NW SUITE 300 | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MI | StateAbbreviationCd |
| ZIP | 49503 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | SEE SCHEDULE O | ServicesDesc |
| Compensation | $474,406 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $106,253 | RelatedOrganizationsAmt |
| Total Contributions | $106,253 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT FEES | 621400 | $292,791 | $292,791 |
| PHYSICIAN INCENTIVES | 621400 | $100,047 | $100,047 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $392,838 | TotalProgramServiceRevenueAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS REVENUE | Desc |
| Business | 623990 | BusinessCd |
| Total Revenue Column | $6 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $6 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $499,097 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $392,844 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,750 | TotalAmt |
| Management And General | $18,750 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $414,887 | TotalAmt |
| Program Services | $414,887 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,590 | TotalAmt |
| Program Services | $29,590 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,429 | TotalAmt |
| Program Services | $25,429 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $650 | TotalAmt |
| Program Services | $650 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $495 | TotalAmt |
| Program Services | $495 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,304 | TotalAmt |
| Program Services | $4,304 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| BANK SERVICE CHARGE | $3,362 | $3,362 | |
| MISCELLANEOUS | $1,444 | $1,444 | |
| OUTSIDE SERVICE | $186 | $186 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $499,097 | TotalAmt |
| Program Services | $476,985 | ProgramServicesAmt |
| Management And General | $22,112 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $699,819 | BOYAmt |
| EOY | $558,216 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $79,517 | BOYAmt |
| EOY | $88,854 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,799 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,714 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,580 | BOYAmt |
| EOY | $8,085 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $787,916 | BOYAmt |
| EOY | $655,155 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $752,399 | BOYAmt |
| EOY | $619,638 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,517 | BOYAmt |
| EOY | $35,517 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $787,916 | BOYAmt |
| EOY | $655,155 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $787,916 | BOYAmt |
| EOY | $655,155 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $0 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,799 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,714 | DepreciationAmt |
| Book Value | $8,085 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,085 | TotalBookValueLandBuildingsAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| DR RAJANI DR RUND S FROST AND | |||
| EMPLOYEES OF SHMG AND BOARD MEMBERS/OFFICERS OF HCHC | $474,406 | SHMG IS REIMBURSED FOR EXPENSES THEY PAY ON BEHALF OF HCHC. | 0 |
| DALE SOWDERS PATTI VANDORT | |||
| EMPLOYEES OF HOLLAND HOSPITAL AND BOARD MEMBER/OFFICER OF HCHC | $24,692 | HH LEASES FACILITY TO HCHC | 0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: | FormAndLineReferenceDesc |
| Explanation | (A) NAME OF INTERESTED PERSON: DR. RAJANI, DR. RUND, S. FROST, AND C. LOMBARDI.(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: EMPLOYEES OF SHMG AND BOARD MEMBERS/OFFICERS OF HCHC(C) DESCRIPTION OF TRANSACTION: SHMG IS REIMBURSED FOR EXPENSES THEY PAY ON BEHALF OF HCHC.(A) NAME OF INTERESTED PERSON: DALE SOWDERS AND PATTI VANDORT(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION: EMPLOYEES OF HOLLAND HOSPITAL AND BOARD MEMBER/OFFICER OF HCHC (C) DESCRIPTION OF TRANSACTION: HH LEASES FACILITY TO HCHC | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | EFFECTIVE APRIL 3, 2022, SPECTRUM HEALTH MEDICAL GROUP WITHDREW AS MEMBER OF HOLLAND COMMUNITY HEALTH CENTER. HOLLAND HOSPITAL REMAINS THE SOLE MEMBER OF HOLLAND COMMUNITY HEALTH CENTER AND HAS CHANGED HOLLAND COMMUNITY HEALTH CENTERS YEAR END FROM DECEMBER 31 TO MARCH 31. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION SHALL HAVE TWO CLASSES (CLASS H AND CLASS P) OF MEMBERS. THERE SHALL BE ONE CLASS H MEMBER, HOLLAND COMMUNITY HOSPITAL, A MICHIGAN NONPROFIT CORPORATION, OF HOLLAND, MICHIGAN. THE CLASS P MEMBERS SHALL BE LIMITED TO MICHIGAN NONPROFIT CORPORATIONS ORGANIZED AND OPERATED FOR THE EMPLOYMENT OF PHYSICIANS, PHYSICIAN-OWNED PROFESSIONAL CORPORATION OR LIMITED LIABILITY COMPANIES, OR OTHER PHYSCIAN GROUPS PRACTICING IN THE HOLLAND, MICHIGAN AREA. APPLICATION FOR MEMBERSHIP SHALL BE SUBMITTED ON FORMS APPROVED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SHALL APPROVE OR REJECT APPLICATIONS FOR MEMBERSHIP; PROVIDED, HOWEVER, THAT IF A VOTE ON ANY SUCH MATTER RESULTS IN A TIE, THE CLASS H MEMBER SHALL HAVE THE RIGHT TO MAKE THE FINAL DECISION ON THE ADMISSION OF THE NEW MEMBER. MEMBERSHIP IN THE CORPORATION SHALL BE PERPETUAL FROM THE DATE OF ACCEPTANCE OF THE MEMBER'S APPLICATION FOR MEMBERSHIP, UNLESS THE MEMBER RESIGNS, DISSOLVES, OR IS EXPELLED. ANY SUCCESSOR ORGANIZATION BY WAY OF A MERGER OR OTHER REORGANIZATION OF A MEMBER SHALL CONTINUE AS A MEMBER OF THE CORPORATION AUTOMATICALLY WITHOUT FURTHER ACTION ON THE PART OF THE MEMBER OR THE CORPORATION. A MEMBER MAY BE EXPELLED BY ACTION OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE; PROVIDED, HOWEVER, THAT IF THE VOTE ON ANY SUCH MATTER RESULTS IN A TIE, THE CLASS H MEMBER SHALL HAVE THE RIGHT TO MAKE THE FINAL DECISION ON THE EXPULSION OF ANY MEMBER. EACH MEMBER SHALL BE ENTITLED TO VOTE ON ANY MATTER FALLING UNDER THE AUTHORITY OF THE MEMBERS AS ESTABLISHED BY THE ARTICLES OF INCORPORATION, THE BY-LAWS OF THE CORPORATION, OR BY LAW. ON ANY MATTER ON WHICH THE MEMBERS ARE VOTING, THE CLASS H MEMBER SHALL HAVE ONE VOTE AND THE CLASS P MEMBERS SHALL COLLECTIVELY HAVE ONE VOTE, SUCH VOTE TO BE DETERMINED BY MAJORITY VOTE AMONG THE CLASS P MEMBERS WITH EACH CLASS P MEMBER HAVE A NUMBER OF VOTES EQUAL TO THE NUMBER OF FULL TIME EQUIVALENT PHYSICIANS EMPLOYED BY OR OWNERS (PARTNERS, CO-MEMBERS, OR SHAREHOLDERS) OF THE CLASS P MEMBER AND PRACTICING IN THE HOLLAND, MICHIGAN AREA. IN ALL OTHER RESPECTS, EACH MEMBER SHALL HAVE IDENTICAL RIGHTS AND PRIVILEDGES, WITHOUT RESPECT TO CLASS, EXCEPT AS MAY BE PROVIDED FOR IN THE BY-LAWS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS SHALL ELECT THE BOARD OF DIRECTORS. THE BOARD SHALL AT ALL TIMES CONSIST OF SIX DIRECTORS, THREE OF WHOM SHALL BE ELECTED BY THE CLASS H MEMBER AND THREE OF WHOM SHALL BE ELECTED BY THE CLASS P MEMBERS BY A COLLECTIVE VOTE AMONG THE CLASS P MEMBERS. THE TERM OF EACH DIRECTOR SHALL BE PERPETUAL, SUBJECT TO THE RESIGNATION AND REMOVAL PROVISIONS PROVIDED FOR. A DIRECTOR MAY RESIGN BY WRITTEN NOTICE TO THE CORPORATION SECRETARY. THE MEMBERS WHO APPOINTED OR ELECTED A DIRECTOR MAY REMOVE THE DIRECTOR WITH OR WITHOUT CAUSE UPON THE SAME VOTE REQUIRED FOR ELECTION. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITHIN THE GOVERNING BODY |
| FORM 990, PART VI, SECTION B, LINE 11B | CARRIE LOMBARDI (BOARD MEMBER) AND JAMES JUNEWICK (FINANCIAL REPORTING MANAGER) REVIEW THE FORM PRIOR TO FILING. THE COMPLETED AND FILED FORM 990 IS PRESENTED TO THE BOARD, HOWEVER, THERE IS NO REVIEW PROCESS BY THE ENTIRE BOARD OF DIRECTORS OF THE FORM 990 PRIOR TO ITS FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY, THE BOARD MEMBERS SIGN THE CONFLICT OF INTEREST FORMS. THE COMPLETED FORMS ARE SENT TO SPECTRUM HEALTH'S RISK AND COMPLIANCE DEPARTMENT WHICH REVIEWS THE FORMS FOR ANY POTENTIAL ISSUES THAT MAY ARISE. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUEST |
| FORM 990, PART VI, SECTION B, LINE 13-14 | HCHC DOES NOT HAVE A FORMAL WRITTEN WHISTLEBLOWER POLICY OR WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. THEY ADHERE TO THE POLICIES THAT HAVE BEEN SET FORTH BY SPECTRUM HEALTH MEDICAL GROUP. |
| FORM 990, PART VII, SECTION A, LINE 1 | DALE SOWDERS RECEIVES COMPENSATION FOR HIS WORK AT HOLLAND HOSPITAL, WHICH IS A FOUNDING MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HIS TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. ALLISON RUND, M.D. RECEIVES COMPENSATION FOR HER WORK AT SPECTRUM HEALTH MEDICAL GROUP, WHICH IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HER TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. SAMIR RAJANI, M.D. IS COMPENSATED FOR HIS WORK AT SPECTRUM HEALTH MEDICAL GROUP, WHICH IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HIS TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. SUE FROST IS COMPENSATED BY SPECTRUM HEALTH MEDICAL GROUP FOR HER WORK AT HOLLAND COMMUNITY HEALTH CENTER. SPECTRUM HEALTH MEDICAL GROUP IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER. SUE IS NOT COMPENSATED FOR HER TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. CARRIE LOMBARDI IS COMPENSATED FOR HER WORK AT SPECTRUM HEALTH MEDICAL GROUP, WHICH IS A MEMBER OF HOLLAND COMMUNITY HEALTH CENTER, BUT IS NOT COMPENSATED FOR HER TIME AND SERVICES PERFORMED TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VII, SECTION B, LINE 1(B) | SPECTRUM HEALTH MEDICAL GROUP PAYS ALL OPERATING EXPENSES OF HCHC AND IS REIMBURSED BY HCHC. |
| FORM 990, PART IX, LINE 11G | PROVIDER AND CLINIC SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 414,887. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 414,887. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| HOLLAND COMMUNITY HOSPITALS | ||||||||||
| 602 MICHIGAN AVENUE | HOLLAND | MI | 49423 | 382800065 | HEALTH CARE NEEDS OF THE HOLLAND COMMUNITY | MI | 501(C)(3) | 3 | N/A | 0 |
| SPECTRUM HEALTH PRIMARY CARE PARTNERS DBA SPECTRUM HEALTH MEDICAL GROUP | ||||||||||
| 648 MONROE NW SUITE 300 | GRAND RAPIDS | MI | 49503 | 381358164 | TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. | MI | 501(C)(3) | 3 | N/A | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| SPECTRUM HEALTH MEDICAL GROUP | ||
| M | $433,673 | COSTS PAID |
| HOLLAND COMMUNITY HOSPITAL | ||
| C | $106,253 | PAYMENTS RECEIVED AND DUE |